Efficacy of Breast Cancer Nomograms and Factors Related to Non-Sentinel Lymph Node Metastasis in Breast Cancer: A Cross Sectional Study

Ahmet Korkut Belli, Osman Simsek, Fatih Aydogan, Erinc Akture, Ahu Demiroz, Zerrin Calay, Varol Celik, Ihsan Tasci

Özet


Sentinel lymph node (SLN) biopsy for breast cancer was accepted and implemented worldwide. Many researchers found that 50-70% of patients with positive SLN biopsy have no further non-sentinel lymph node (NSLN) metastasis. Memorial Sloan Kettering Cancer Center (MSKCC) and Stanford nomograms are the two online calculators to identify patients who have low risk for NSLN metastasis. Aim to validate MSKCC and Stanford nomograms and to investigate which patient characteristics are effective on NSLN metastasis. Between May 2003 and June 2008 patients who underwent SLN biopsy due to breast cancer enrolled to the study. Patient clinicopathologic features and NSLN status were recorded. NSLN metastasis risks were calculated by MSKCC and Stanford nomograms. The relations between the risk scores and NSLN status, NSLN status and patient features were investigated. Results: The AUC values for MSKCC and Stanford nomograms were 0.651 (p=0.004) and 0.631 (p=0.001)   respectively. Mean age of the patients were 51.4 (30-85); mean tumor size were 2.70 cm (0.7-8.5).  Micrometastasis, macrometastasis and SLN involvement proportions were found statistically significant for NSLN metastasis. Age, tumor size, histology, grade, lymphatic invasion, multifocality and estrogen receptor status were found statistically insignificant. Both MSKCC and Stanford nomograms weakly predicted NSLN metastasis in our patient group. Although the value of the nomograms seems to be diminished after Z011 study, if improved, they can help physicians and patients to decide whether ALND is beneficial in preventing and controlling loco-regional or systemic disease recurrence.

Keywords: Axillary metastasis, breast cancer, breast cancer nomogram, sentinel lymph node, SLN biopsy


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